Which Antibiotics will work and which not in
neonatal sepsis in INDIA
Real case scenario
26 year old primiElective LSCS deli for non progressive labor
Male 34 kg Cried at birth
Respi Distress at birth
On ventilator at 6 hrs
Referred to local NICU for further support
Ive had the struggle of living with a resistance to
antibiotics for nearly eight years of my lifethere is a
clear need for new antibiotics
With every sting and every pain my heart sinks at the
thought of how many antibiotics I have
left to use this time
Indian J Med Res 2008 Jan127(1)85-8
Occurrence of ESBL amp Amp-C beta-lactamases amp susceptibility to newer antimicrobial agents in complicated UTITaneja N1 Rao P Arora J Dogra A
Neonatal Sepsis High Antibiotic Resistance of the Bacterial Pathogens in a Neonatal Intensive Care Unit of a Tertiary Care
HospitalNosocomial Infections in Neonatal Intensive Care Units Profile Risk Factor Assessment and Antibiogram
Saritha Kamath Shrikara Mallaya and Shalini Shenoy
Department of Microbiology Kasturba Medical College Mangalore Karnataka India
Indian J Pediatr 2011 Apr78(4)409-12 doi 101007s12098-010-0272-1 Epub 2010 Oct 17
Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre in eastern India a 3 year
study
Indian J Pediatr 2011 Apr78(4)409-12 doi 101007s12098-010-0272-1 Epub 2010 Oct 17
Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre
in eastern India a 3 year studyViswanathan R1 Singh AK Mukherjee S Mukherjee R Das P Basu S
135 268 blood cultures
425 cities and 27 states
1820 collection centres
Acenatobacter most common org
HIGH degree of resistance to
Reserve antibiotics
Almost 50 CS positive died
25 of all death were bcs of sepsis
Mortality almost same between sensitive
and resistance pathogens
Nearly quarter of
Acinetobacter and three
quarter of Klebsiella
showed NDM-1 in pool of
carb Resistance strain
Early occurrence of Sepsis (most episodes occurred with
in 72 hrs )
Quarter of culture positive episodes occurred with in 24
hrs of birth
two third with in 72 hrs
CFR did not differ between Early or late onset
Antibiotic resistancemdashthe need for global solutions
Ramanan Laxminarayan PhD Adriano Duse MD Chand Wattal MD Anita K M Zaidi MD Heiman F L Wertheim MD Nithima
Sumpradit PhD Erika Vlieghe MD Prof Gabriel Levy Hara MD Ian M Gould MBChB Herman Goossens PhD Christina Greko PhD
Prof Anthony D So MD Maryam Bigdeli MPH Prof Goumlran Tomson MD Will Woodhouse Eva Ombaka PhD Prof Arturo Quizhpe
Peralta MD Farah Naz Qamar MBBS Fatima Mir PhD Sam Kariuki PhD Prof Zulfiqar A Bhutta PhD Prof Anthony Coates MD
Richard Bergstrom MSc Gerard D Wright PhD Eric D Brown PhD Prof Otto Cars MD
The Lancet Infectious Diseases
Volume 13 Issue 12 Pages 1057-1098 (December 2013) DOI 101016S1473-3099(13)70318-9
Copyright copy 2013 Elsevier Ltd Terms and Conditions
Volume 17 Number 10mdashOctober 2011
Worldwide geographic distribution ofKlebsiella pneumoniaecarbapenemase (KPC)
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Real case scenario
26 year old primiElective LSCS deli for non progressive labor
Male 34 kg Cried at birth
Respi Distress at birth
On ventilator at 6 hrs
Referred to local NICU for further support
Ive had the struggle of living with a resistance to
antibiotics for nearly eight years of my lifethere is a
clear need for new antibiotics
With every sting and every pain my heart sinks at the
thought of how many antibiotics I have
left to use this time
Indian J Med Res 2008 Jan127(1)85-8
Occurrence of ESBL amp Amp-C beta-lactamases amp susceptibility to newer antimicrobial agents in complicated UTITaneja N1 Rao P Arora J Dogra A
Neonatal Sepsis High Antibiotic Resistance of the Bacterial Pathogens in a Neonatal Intensive Care Unit of a Tertiary Care
HospitalNosocomial Infections in Neonatal Intensive Care Units Profile Risk Factor Assessment and Antibiogram
Saritha Kamath Shrikara Mallaya and Shalini Shenoy
Department of Microbiology Kasturba Medical College Mangalore Karnataka India
Indian J Pediatr 2011 Apr78(4)409-12 doi 101007s12098-010-0272-1 Epub 2010 Oct 17
Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre in eastern India a 3 year
study
Indian J Pediatr 2011 Apr78(4)409-12 doi 101007s12098-010-0272-1 Epub 2010 Oct 17
Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre
in eastern India a 3 year studyViswanathan R1 Singh AK Mukherjee S Mukherjee R Das P Basu S
135 268 blood cultures
425 cities and 27 states
1820 collection centres
Acenatobacter most common org
HIGH degree of resistance to
Reserve antibiotics
Almost 50 CS positive died
25 of all death were bcs of sepsis
Mortality almost same between sensitive
and resistance pathogens
Nearly quarter of
Acinetobacter and three
quarter of Klebsiella
showed NDM-1 in pool of
carb Resistance strain
Early occurrence of Sepsis (most episodes occurred with
in 72 hrs )
Quarter of culture positive episodes occurred with in 24
hrs of birth
two third with in 72 hrs
CFR did not differ between Early or late onset
Antibiotic resistancemdashthe need for global solutions
Ramanan Laxminarayan PhD Adriano Duse MD Chand Wattal MD Anita K M Zaidi MD Heiman F L Wertheim MD Nithima
Sumpradit PhD Erika Vlieghe MD Prof Gabriel Levy Hara MD Ian M Gould MBChB Herman Goossens PhD Christina Greko PhD
Prof Anthony D So MD Maryam Bigdeli MPH Prof Goumlran Tomson MD Will Woodhouse Eva Ombaka PhD Prof Arturo Quizhpe
Peralta MD Farah Naz Qamar MBBS Fatima Mir PhD Sam Kariuki PhD Prof Zulfiqar A Bhutta PhD Prof Anthony Coates MD
Richard Bergstrom MSc Gerard D Wright PhD Eric D Brown PhD Prof Otto Cars MD
The Lancet Infectious Diseases
Volume 13 Issue 12 Pages 1057-1098 (December 2013) DOI 101016S1473-3099(13)70318-9
Copyright copy 2013 Elsevier Ltd Terms and Conditions
Volume 17 Number 10mdashOctober 2011
Worldwide geographic distribution ofKlebsiella pneumoniaecarbapenemase (KPC)
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Ive had the struggle of living with a resistance to
antibiotics for nearly eight years of my lifethere is a
clear need for new antibiotics
With every sting and every pain my heart sinks at the
thought of how many antibiotics I have
left to use this time
Indian J Med Res 2008 Jan127(1)85-8
Occurrence of ESBL amp Amp-C beta-lactamases amp susceptibility to newer antimicrobial agents in complicated UTITaneja N1 Rao P Arora J Dogra A
Neonatal Sepsis High Antibiotic Resistance of the Bacterial Pathogens in a Neonatal Intensive Care Unit of a Tertiary Care
HospitalNosocomial Infections in Neonatal Intensive Care Units Profile Risk Factor Assessment and Antibiogram
Saritha Kamath Shrikara Mallaya and Shalini Shenoy
Department of Microbiology Kasturba Medical College Mangalore Karnataka India
Indian J Pediatr 2011 Apr78(4)409-12 doi 101007s12098-010-0272-1 Epub 2010 Oct 17
Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre in eastern India a 3 year
study
Indian J Pediatr 2011 Apr78(4)409-12 doi 101007s12098-010-0272-1 Epub 2010 Oct 17
Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre
in eastern India a 3 year studyViswanathan R1 Singh AK Mukherjee S Mukherjee R Das P Basu S
135 268 blood cultures
425 cities and 27 states
1820 collection centres
Acenatobacter most common org
HIGH degree of resistance to
Reserve antibiotics
Almost 50 CS positive died
25 of all death were bcs of sepsis
Mortality almost same between sensitive
and resistance pathogens
Nearly quarter of
Acinetobacter and three
quarter of Klebsiella
showed NDM-1 in pool of
carb Resistance strain
Early occurrence of Sepsis (most episodes occurred with
in 72 hrs )
Quarter of culture positive episodes occurred with in 24
hrs of birth
two third with in 72 hrs
CFR did not differ between Early or late onset
Antibiotic resistancemdashthe need for global solutions
Ramanan Laxminarayan PhD Adriano Duse MD Chand Wattal MD Anita K M Zaidi MD Heiman F L Wertheim MD Nithima
Sumpradit PhD Erika Vlieghe MD Prof Gabriel Levy Hara MD Ian M Gould MBChB Herman Goossens PhD Christina Greko PhD
Prof Anthony D So MD Maryam Bigdeli MPH Prof Goumlran Tomson MD Will Woodhouse Eva Ombaka PhD Prof Arturo Quizhpe
Peralta MD Farah Naz Qamar MBBS Fatima Mir PhD Sam Kariuki PhD Prof Zulfiqar A Bhutta PhD Prof Anthony Coates MD
Richard Bergstrom MSc Gerard D Wright PhD Eric D Brown PhD Prof Otto Cars MD
The Lancet Infectious Diseases
Volume 13 Issue 12 Pages 1057-1098 (December 2013) DOI 101016S1473-3099(13)70318-9
Copyright copy 2013 Elsevier Ltd Terms and Conditions
Volume 17 Number 10mdashOctober 2011
Worldwide geographic distribution ofKlebsiella pneumoniaecarbapenemase (KPC)
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Indian J Med Res 2008 Jan127(1)85-8
Occurrence of ESBL amp Amp-C beta-lactamases amp susceptibility to newer antimicrobial agents in complicated UTITaneja N1 Rao P Arora J Dogra A
Neonatal Sepsis High Antibiotic Resistance of the Bacterial Pathogens in a Neonatal Intensive Care Unit of a Tertiary Care
HospitalNosocomial Infections in Neonatal Intensive Care Units Profile Risk Factor Assessment and Antibiogram
Saritha Kamath Shrikara Mallaya and Shalini Shenoy
Department of Microbiology Kasturba Medical College Mangalore Karnataka India
Indian J Pediatr 2011 Apr78(4)409-12 doi 101007s12098-010-0272-1 Epub 2010 Oct 17
Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre in eastern India a 3 year
study
Indian J Pediatr 2011 Apr78(4)409-12 doi 101007s12098-010-0272-1 Epub 2010 Oct 17
Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre
in eastern India a 3 year studyViswanathan R1 Singh AK Mukherjee S Mukherjee R Das P Basu S
135 268 blood cultures
425 cities and 27 states
1820 collection centres
Acenatobacter most common org
HIGH degree of resistance to
Reserve antibiotics
Almost 50 CS positive died
25 of all death were bcs of sepsis
Mortality almost same between sensitive
and resistance pathogens
Nearly quarter of
Acinetobacter and three
quarter of Klebsiella
showed NDM-1 in pool of
carb Resistance strain
Early occurrence of Sepsis (most episodes occurred with
in 72 hrs )
Quarter of culture positive episodes occurred with in 24
hrs of birth
two third with in 72 hrs
CFR did not differ between Early or late onset
Antibiotic resistancemdashthe need for global solutions
Ramanan Laxminarayan PhD Adriano Duse MD Chand Wattal MD Anita K M Zaidi MD Heiman F L Wertheim MD Nithima
Sumpradit PhD Erika Vlieghe MD Prof Gabriel Levy Hara MD Ian M Gould MBChB Herman Goossens PhD Christina Greko PhD
Prof Anthony D So MD Maryam Bigdeli MPH Prof Goumlran Tomson MD Will Woodhouse Eva Ombaka PhD Prof Arturo Quizhpe
Peralta MD Farah Naz Qamar MBBS Fatima Mir PhD Sam Kariuki PhD Prof Zulfiqar A Bhutta PhD Prof Anthony Coates MD
Richard Bergstrom MSc Gerard D Wright PhD Eric D Brown PhD Prof Otto Cars MD
The Lancet Infectious Diseases
Volume 13 Issue 12 Pages 1057-1098 (December 2013) DOI 101016S1473-3099(13)70318-9
Copyright copy 2013 Elsevier Ltd Terms and Conditions
Volume 17 Number 10mdashOctober 2011
Worldwide geographic distribution ofKlebsiella pneumoniaecarbapenemase (KPC)
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
135 268 blood cultures
425 cities and 27 states
1820 collection centres
Acenatobacter most common org
HIGH degree of resistance to
Reserve antibiotics
Almost 50 CS positive died
25 of all death were bcs of sepsis
Mortality almost same between sensitive
and resistance pathogens
Nearly quarter of
Acinetobacter and three
quarter of Klebsiella
showed NDM-1 in pool of
carb Resistance strain
Early occurrence of Sepsis (most episodes occurred with
in 72 hrs )
Quarter of culture positive episodes occurred with in 24
hrs of birth
two third with in 72 hrs
CFR did not differ between Early or late onset
Antibiotic resistancemdashthe need for global solutions
Ramanan Laxminarayan PhD Adriano Duse MD Chand Wattal MD Anita K M Zaidi MD Heiman F L Wertheim MD Nithima
Sumpradit PhD Erika Vlieghe MD Prof Gabriel Levy Hara MD Ian M Gould MBChB Herman Goossens PhD Christina Greko PhD
Prof Anthony D So MD Maryam Bigdeli MPH Prof Goumlran Tomson MD Will Woodhouse Eva Ombaka PhD Prof Arturo Quizhpe
Peralta MD Farah Naz Qamar MBBS Fatima Mir PhD Sam Kariuki PhD Prof Zulfiqar A Bhutta PhD Prof Anthony Coates MD
Richard Bergstrom MSc Gerard D Wright PhD Eric D Brown PhD Prof Otto Cars MD
The Lancet Infectious Diseases
Volume 13 Issue 12 Pages 1057-1098 (December 2013) DOI 101016S1473-3099(13)70318-9
Copyright copy 2013 Elsevier Ltd Terms and Conditions
Volume 17 Number 10mdashOctober 2011
Worldwide geographic distribution ofKlebsiella pneumoniaecarbapenemase (KPC)
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Acenatobacter most common org
HIGH degree of resistance to
Reserve antibiotics
Almost 50 CS positive died
25 of all death were bcs of sepsis
Mortality almost same between sensitive
and resistance pathogens
Nearly quarter of
Acinetobacter and three
quarter of Klebsiella
showed NDM-1 in pool of
carb Resistance strain
Early occurrence of Sepsis (most episodes occurred with
in 72 hrs )
Quarter of culture positive episodes occurred with in 24
hrs of birth
two third with in 72 hrs
CFR did not differ between Early or late onset
Antibiotic resistancemdashthe need for global solutions
Ramanan Laxminarayan PhD Adriano Duse MD Chand Wattal MD Anita K M Zaidi MD Heiman F L Wertheim MD Nithima
Sumpradit PhD Erika Vlieghe MD Prof Gabriel Levy Hara MD Ian M Gould MBChB Herman Goossens PhD Christina Greko PhD
Prof Anthony D So MD Maryam Bigdeli MPH Prof Goumlran Tomson MD Will Woodhouse Eva Ombaka PhD Prof Arturo Quizhpe
Peralta MD Farah Naz Qamar MBBS Fatima Mir PhD Sam Kariuki PhD Prof Zulfiqar A Bhutta PhD Prof Anthony Coates MD
Richard Bergstrom MSc Gerard D Wright PhD Eric D Brown PhD Prof Otto Cars MD
The Lancet Infectious Diseases
Volume 13 Issue 12 Pages 1057-1098 (December 2013) DOI 101016S1473-3099(13)70318-9
Copyright copy 2013 Elsevier Ltd Terms and Conditions
Volume 17 Number 10mdashOctober 2011
Worldwide geographic distribution ofKlebsiella pneumoniaecarbapenemase (KPC)
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Early occurrence of Sepsis (most episodes occurred with
in 72 hrs )
Quarter of culture positive episodes occurred with in 24
hrs of birth
two third with in 72 hrs
CFR did not differ between Early or late onset
Antibiotic resistancemdashthe need for global solutions
Ramanan Laxminarayan PhD Adriano Duse MD Chand Wattal MD Anita K M Zaidi MD Heiman F L Wertheim MD Nithima
Sumpradit PhD Erika Vlieghe MD Prof Gabriel Levy Hara MD Ian M Gould MBChB Herman Goossens PhD Christina Greko PhD
Prof Anthony D So MD Maryam Bigdeli MPH Prof Goumlran Tomson MD Will Woodhouse Eva Ombaka PhD Prof Arturo Quizhpe
Peralta MD Farah Naz Qamar MBBS Fatima Mir PhD Sam Kariuki PhD Prof Zulfiqar A Bhutta PhD Prof Anthony Coates MD
Richard Bergstrom MSc Gerard D Wright PhD Eric D Brown PhD Prof Otto Cars MD
The Lancet Infectious Diseases
Volume 13 Issue 12 Pages 1057-1098 (December 2013) DOI 101016S1473-3099(13)70318-9
Copyright copy 2013 Elsevier Ltd Terms and Conditions
Volume 17 Number 10mdashOctober 2011
Worldwide geographic distribution ofKlebsiella pneumoniaecarbapenemase (KPC)
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Antibiotic resistancemdashthe need for global solutions
Ramanan Laxminarayan PhD Adriano Duse MD Chand Wattal MD Anita K M Zaidi MD Heiman F L Wertheim MD Nithima
Sumpradit PhD Erika Vlieghe MD Prof Gabriel Levy Hara MD Ian M Gould MBChB Herman Goossens PhD Christina Greko PhD
Prof Anthony D So MD Maryam Bigdeli MPH Prof Goumlran Tomson MD Will Woodhouse Eva Ombaka PhD Prof Arturo Quizhpe
Peralta MD Farah Naz Qamar MBBS Fatima Mir PhD Sam Kariuki PhD Prof Zulfiqar A Bhutta PhD Prof Anthony Coates MD
Richard Bergstrom MSc Gerard D Wright PhD Eric D Brown PhD Prof Otto Cars MD
The Lancet Infectious Diseases
Volume 13 Issue 12 Pages 1057-1098 (December 2013) DOI 101016S1473-3099(13)70318-9
Copyright copy 2013 Elsevier Ltd Terms and Conditions
Volume 17 Number 10mdashOctober 2011
Worldwide geographic distribution ofKlebsiella pneumoniaecarbapenemase (KPC)
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Volume 17 Number 10mdashOctober 2011
Worldwide geographic distribution ofKlebsiella pneumoniaecarbapenemase (KPC)
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Volume 17 Number 10mdashOctober 2011
Geographic distribution of New Delhi metallo-β-lactamase-1 producers
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Verona integronndashencoded metallo-β-lactamase (VIM)
and IMP enterobacterial producers
Verona integronndashencoded metallo-β-lactamase (VIM) and IMP
enterobacterial producers
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
oxacillinase-48 (OXA-48) type producers
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Klebsiella pneumoniae carbapenemase-2 (KPC-2
New Delhi metallo-β-lactamase-1 (NDM-1)
oxacillinase-48 (OXA-48)ndashproducingK Pneumoniae
Volume 17 Number 10mdashOctober 2011
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Worst for BRICK countries
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
ACCESSEXCESS
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Prolonged course of antibiotics
Undisciplined use of broad spectrum antibiotics
Overdependence on CRP to startstop antibiotics
Absence of culture facilities
ESBL MRSAVRE
Carbepenem resistance
NDM -1
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Poor public health infrastructure Rising income high burden of disease unregulated sale of antibiotics
50 samples from street taps mdash sources of drinking
washing and cooking water for entire neighborhoods mdash
and 171 samples of ―seepage (surface water and
street puddles) from around New Delhi NDM-1 in two
of the drinking-water samples (4 percent) and 51 of the
171 seepage samples (30 percent)
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
The Lancet Infectious Diseases 2013 13 1057-1098DOI (101016S1473-3099(13)70318-9)
Trends in retail sales of carbapenem antibiotics for Gram-negative bacteria
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Antibiotic Therapy in Neonates No prophylactic antibiotics
Prophylactic antibiotics tried in
Prematurity
MSAF
All ventilated babies
Chest drains exchange etc
Prophylaxis ndash
Increases risk of infection with Multi drug resistant pathogen
Predispose to antibiotic resistance
Does not
prevent Sepsis
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Antibiotic Therapy in Neonates Treat infection and not colonisation
Bacteria isolated from ET tube catheters long lines constitute
colonization
Do not use antibiotics for colonization
It is likely to increase antibiotic resistance and
It does not prevent systemic infection
Growth of bacterium from normally sterile body sites such as
blood CSF ascitic tap pleural tap etc suggests infection
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Role of Infection Control
Strict hand washing- Before examining first baby a
thorough hand wash with detergent soap for at least 2 min
and in-between babies hand wash for 30 sec
Strict asepsis during any procedure
Periodic review of antibiotic policy in the light of culture
positive reports in the previous month
Rotation of antibiotics
Periodic fumigation
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
NICU policieshellip
Not to admit diarrhoea patients and patients
with open infected wounds in nicu
Isolation of culture positive septic babies
Restriction of visitors
Kangaroo mother care
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Ten Point Action Plan on Antibiotic Use
Always take blood cultures prior to start of antibiotics
Use the narrowest spectrum antibiotics possible almost always a penicillin and
an aminoglycoside (eg Amikacin)
Do not start treatment as a general rule with a 3rd generation cephalosporin
(eg cefotaxime ceftazidime) or a carbapenem (eg imipenem
meropenem)
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Ten Point Action Plan on Antibiotic Use
Develop local antibiotic policies to restrict the use of expensive
broad-spectrum antibiotics like imipenem for emergency
treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to
stop antibiotics
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Develop local antibiotic policies to restrict the use of expensive broad-spectrum
antibiotics like imipenem for emergency treatment
Trust the microbiology laboratory Rely on the blood culture results
Stop believing that a raised CRP means the baby is definitely septic
If blood cultures are negative at 2-3 days it is almost always safe to stop antibiotics
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
TRY YOUR LUCK
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Conclusions
Canrsquot predict which antibiotics will work and which will not in current scenario of MDRS organism
Go by org pattern and CS sensitivity of your set up
Prevention of sepsis has to be a priority and on war foot basis
Ten rule of antibiotics usage is MUST to be observed
itrsquos a Question of our own image as a communitycountry
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets
Lord Jim ONeill who led the Review on Antimicrobial
Resistance said a campaign was needed to stop
people treating antibiotics like sweets